There are six months left for optometrists to prepare to adopt new coding guidelines—and the AOA is at the ready to provide guidance and support.
In the spring of 2014, federal regulators pushed back the compliance deadline for the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) to October 1, 2015. Once in effect, this will serve as the new system for reporting medical conditions on insurance claims and in patient records.
For optometry, the additional year to prepare "was a blessing in disguise," says AOA Trustee Gregory Caldwell, O.D. Providers have had extra time to address some of the barriers to ICD-10 that existed last year, such as figuring out the right codes for the right patients and payers. In addition, information technology vendors have fixed some glitches in getting the proper upgrades required of electronic health records (EHRs).
Having the right EHR in place is critical. Dr. Caldwell says his office's EHR has proved invaluable. The software his office uses allows him to type in an ICD-9 code, and it will provide the equivalent ICD-10 code he's looking for.
ICD-10 will be offering at least 70,000 potential choices for coding diagnoses and causes of medical conditions. Only half may apply to ODs, yet at this time, everyone in the profession should be working to prepare for this major code change.
AOA offers several ICD-10 resources
Dr. Caldwell emphasizes that the AOA is available to support members through this transition. "This is something the AOA is not taking lightly. We have invested in a lot of resources, and we certainly want our members to realize that we're here for them."
- The AOA's Third Party Center Coding Experts, who are available to answer questions about ICD-10 and other coding topics at firstname.lastname@example.org.
- Kara Webb, the AOA's associate director for coding and regulatory policy, is also available to answer questions about ICD-10 and related topics at KCWebb@aoa.org.
- AOACodingToday.com, a no-cost, members-only, online resource that offers CPT/ICD-9/ICD-10 information.
- The 2015 Coding Bundle, which includes the 2015 AOA ICD-10 Codes for Optometry Book, 2015 AMA Professional Edition CPT Book and AOA Express Mapping Card. A digital download version of the Codes for Optometry Book is also available.
How the AOA Coding Experts are preparing
One of AOA's three Coding Experts, Dr. Harvey Richman, O.D., says to prepare for the transition, he and his staff first looked at the primary diagnoses that the office uses, then purchased the 2014 and 2015 AOA ICD-10 Codes for Optometry Book and Express Mapping Card for reference. In addition, AOACodingToday.com provides all coding information an OD needs in a digital format, as well as a handy code lookup feature, Dr. Richman says.
His practice's EHR vendor advised office staff that it would be ready to roll out the latest version of the ICD-10 software sometime this year. In addition, "our claims clearinghouse has confirmed that they have completed testing, so now all we have to do is make sure that the payers are ready," Dr. Richman says. Members should check with their EHR vendor and claims clearinghouse.
Another Coding Expert, Doug Morrow, O.D., says his office has just begun training on ICD-10. In addition to the AOA codes and mapping card and using AOACodingToday.com, the office has looked to the AOA webinars.
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Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2024, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.